Temporal Changes in Cardiovascular Remodeling Associated with Football Participation

• Type of Material: Article
• Authors: Jonathan Kim, Emory University; Casey Hollowed, Emory Clinical Cardiovascular Research Institute; Keyur Patel, Emory Clinical Cardiovascular Research Institute; Kareem Hosny, Emory Clinical Cardiovascular Research Institute; Hiroshi Aida, Emory Clinical Cardiovascular Research Institute; Zaina Gowani, Emory Clinical Cardiovascular Research Institute; Salman Sher, Emory University; James L. Shoop, Georgia Institute of Technology; Angelo Galante, Emory University; Craig Clark, Furman University; Thomas Marshall, Marist School; Gene Patterson, Woodward Academy; Gary Schmitt, St Pius X School; Yi-An Ko, Emory University; Arshed Ali Quyyumi, Emory University; Aaron L. Baggish, Massachusetts General Hospital
• Language: English
• Date: 2018-09-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2018 by the American College of Sports Medicine.
• Final Published Version (URL): http://dx.doi.org/10.1249/MSS.0000000000001631
• Title of Journal or Parent Work: Medicine and Science in Sports and Exercise
• ISSN: 0195-9131
• Volume: 50
• Issue: 9
• Start Page: 1892
• End Page: 1898
• Grant/Funding Information: This work was supported by U.S. National Institutes of Health/National Heart, Lung, and Blood Institute research grant K23 HL128795 (to Dr. Kim).
• Keywords: PULSE-WAVE VELOCITY; Life Sciences & Biomedicine; ARTERIAL STIFFNESS; FOOTBALL; MORTALITY; BLOOD-PRESSURE; LEFT-VENTRICULAR HYPERTROPHY; PREDICTION; DIASTOLIC DYSFUNCTION; EVENTS; Science & Technology; PROGNOSTIC VALUE; DIASTOLIC FUNCTION; CARDIAC REMODELING; Sport Sciences; MASS
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

Purpose: American-style football (ASF) participation rates in the United States are highest among high school (HS) athletes. This study sought to compare the cardiovascular response to HS versus collegiate ASF participation. Methods: The ASF participants (HS, n = 61; collegiate, n = 87) were studied at preseason and postseason time points with echocardiography and applanation tonometry. Primary outcome variables included: left ventricular (LV) mass index, LV diastolic function (early relaxation velocity [E′]), and arterial stiffness (pulse wave velocity [PWV]). Results: High school (17.1 ± 0.4 yr) and collegiate ASF participants (18 ± 0.4 yr) experienced similar LV hypertrophy (ΔLV mass HS = 10.5 ± 10 vs collegiate = 11.2 ± 13.6 g·m-2, P = 0.97). Among HS participants, increases in LV mass were associated with stable diastolic tissue velocities (ΔE′ = -0.3 ± 2.9 cm·s-1, P = 0.40) and vascular function (ΔPWV = -0.1 ± 0.6 m·s-1, P = 0.13). In contrast, collegiate participants demonstrated a higher burden of concentric LV hypertrophy (21/87, 24% vs 7/61, 11%, P = 0.026) with concomitant reductions in diastolic tissue velocities (ΔE′: -2.0 ± 2.7 cm·s-1, P < 0.001) and increased arterial stiffness (ΔPWV: Δ0.2 ± 0.6 m·s-1, P = 0.003), changes that were influenced by linemen who had the highest post-season weight (124 ± 10 kg) and systolic blood pressure ([SBP], 138.8 ± 11 mm Hg). In multivariable analyses adjusting for age and ethnicity, body mass was an independent predictor of post-season PWV (β estimate = 0.01, P = 0.04) and E′ (β estimate = -0.04, P = 0.05), whereas SBP was an independent predictor of postseason LV mass index (β estimate = 0.18, P = 0.01) and PWV (β estimate = 0.01, P = 0.007). Conclusions: The transition from HS to college represents an important physiologic temporal data point after which differential ASF cardiovascular phenotypes manifest. Future work aimed to clarify underlying mechanisms, and the long-term clinical implications of these findings is warranted.